Life Insurance Lawyer Maine

Whether you reside in: Auburn; Bangor; Biddeford; Lewiston or Portland;
our life insurance attorneys who live and work here in Maine are here
to help resolve your delayed or denied life insurance claim.

Can a greedy life insurance agent jeopardize your policy?

There are few more dangerous forces in business than greed. Unfortunately,
however, greed can strike almost any industry and can wreak havoc for
the unsuspecting. The life insurance industry is rife with greed.

Take, for example, the very manner in which life insurance companies conduct
business. The goal of every life insurance company is to collect the greatest
amount of premiums from the greatest amount of policyholders. That would
be all fine and good if life insurers then routinely paid out death benefits
when those premium-paying policyholders died.

That’s not always what happens. Instead, the insurance companies
hire armies of lawyers whose sole job is to concoct phony reasons to deny
valid claims against those policies. They do this because the fewer claims
they have to pay out, the greater their profits. As lawyers who specialize
in the wrongful denial of life insurance claims, we see insurance companies
engage in these illicit tactics every day.

To add insult to injury, the greed doesn’t stop at the corporate
level. Some life insurance agents, themselves motivated by greed and high
pressure to sell policies, engage in tactics that are every bit as harmful
to the consumer. This article explores the circumstances surrounding one
such agent, and the disastrous impact he had on policyholders in his small
town. While we typically like to report on cases where a policy beneficiary
triumphed against a bogus claim denial by a life insurer, this article
is more of a cautionary tale for those who may be in the process of obtaining
insurance.

Handling the life insurance application process

With some limited exceptions, nearly all life insurance policies require
the policyholder to undergo an application process before a policy can
issue. While the thoroughness of that process varies from company to company
(and policy to policy), it typically involves some level of investigation
into the applicant’s health history. In most cases, that investigation
involves a detailed health questionnaire, followed by a simple physical
examination.

The requirement of truthfulness in the application process cannot be understated.
A life insurance policy, at its core, is a legal contract. Contracts must
be premised on the truth. Otherwise, the party who was lied to during
contract negotiations may later be able to rescind the contract.

In the life insurance context, that means that a policy applicant must
give the insurance company truthful information about his health history.
If he does not, and later dies of an undisclosed medical condition, the
insurer may be able to avoid its obligation to pay a death benefit to
policy beneficiaries. Fortunately, most people understand this and are
truthful in answering questions about their health.

Beware of agents who want to answer health questionnaires for you

As noted above, insurance agents can be under tremendous pressure to sell
policies. This may be because they are paid a commission based on a percentage
of premiums, or simply because they want to get ahead within their agency
by selling more policies than anyone else. Regardless of the motivation,
some life insurance agents play some pretty dirty tricks to meet their
policy quotas.

Such was the case with one agent named Tim. Tim’s game was relatively
simple. Every time he met a new client who wanted to purchase a life insurance
policy, Tim would set up a phone call with that person to go over the
extensive health questionnaire required by the insurance companies he
represented. Tim asked each client to set aside one to two hours for the
call. During that call, Tim would read each question on the application
aloud to the client, and then record their answers on an application form
that would be submitted to the insurance company. Tim touted this process
as “gold standard customer service.”

The only problem was, Tim didn’t always record the client’s
answers to the questions correctly. He knew, for example, that if a client
reported a history of diabetes, heart disease, or cancer, the insurance
company was unlikely to issue a policy. Consequently, Tim would not receive
a commission for his work. Therefore, even if a client did report a serious
medical condition to him during the call, Tim would purposefully fail
to report it on the form, a policy would issue, and Tim would be credited
for the sale.

A series of denied claims

This process worked very well for Tim until his clients started passing
away. For example, Tim submitted an application for one client who admitted
to him during the call that he had been under a doctor’s care for
heart disease for over a year. Tim, however, never noted that information
on the form that went to the insurer. When the client died of a heart
attack just over a year after the policy issued, the insurance company
undertook a medical investigation.

It didn’t take much for the insurance company to discover the client’s
history of serious heart-related health problems. The insurance company
filed a lawsuit to rescind the policy without paying the death benefit
because, it argued, the policy had been issued based on fraudulent information.
When the court granted that rescission, the policyholder’s beneficiaries
lost out on the death benefit that was intended for them.

In short order, other similar cases arose involving this same agent. While
we would like to report that the courts showed mercy on the unsuspecting
beneficiaries, that was simply not the case. The court found that the
policyholder was ultimately responsible for verifying the truth of the
information it submitted to the insurance company. By failing to review
Tim’s form, they failed to ensure the truthfulness of the application.

The point of this story is simple: you must be in charge of your own life
insurance application. Don’t let an agent or anyone else submit
the application for you. If have questions about the application process
or have had a claim denied in a manner you feel is wrongful, please call
us today. We’re here to help.

Maine denied life insurance claims are nothing new. Existing for many years,
life insurance policies have been used to safeguard families and friends
alike in case emergencies or accidents come unexpectedly. Unfortunately,
denials of life insurance claims, as well as delays, are commonplace.

Our life insurance lawyers who live and work in Maine can help, whether
you are in: Portland; Lewiston; Bangor; Auburn; or anywhere in the state
of Maine, we will get you the benefits to which you are entitled.

Number one is a misrepresentation on the application. This typically involves
failing to disclose a medical condition. However, we can get over this
hurdle the majority of the time.

A lapse of a life insurance policy is probably second most common. What
happens is that the insured gets sick and misses a payment or two. These
are tough, but often we can get these claims paid.

Probably third is the type of death exclusion. This could be a suicide
or it could be a self-inflicted injury. Murder is another exclusion. Health
again can fall under this exclusion. We often win suicide exclusions as
we cite case law that the death was actually accidental.

A very common exclusion is the alcohol exclusion. The insured may have
been killed in a car crash, but the autopsy revealed alcohol in the person’s
system. We have many legal briefs to combat this exclusion.

Heroin and opiates or illegal drug exclusion is one of the biggest now.
With the opioid crisis, there are tens of thousands of deaths.

Prescription drug overdose exclusion may involve an overdose of medicine
or taken medicines that are contraindicated.

An ex-spouse being cut off from life insurance benefits is a big one. We
actually have a half dozen ways to get over this hurdle.

Having a spouse not listed as a beneficiary is another reason for denial

Having a child not listed as a beneficiary is one too.

Having only a primary beneficiary who is deceased is another.

On an AD&D (accidental death and dismemberment) life insurance policy,
a fall not being considered an accident is extremely common.

The insured’s age not being correct on the initial application is
a reason for denial.

Having the wrong social security number listed is common.

An autoerotic asphyxiation exclusion is an easy one for us to beat.

An omission on the application is a big reason for denying a life insurance
claim, but we have legal briefs to this effect.

Not providing the required documents to the insurance company after death
is a reason.

Information which is argued to not be correct is one.

When there is a dispute between two or more beneficiaries, an interpleader
may occur, and we always get these resolved quickly.

A beneficiary not named is a reason for not paying it out.

A life insurance policy may be transferred from one company to another
by the employer which causes major problems.

Just because someone likes to ride doesn’t mean they’re not
entitled to benefits

Motorcycle riding is an undeniably popular hobby in the United States.
According to the Department of Transportation, there are nearly 8.5 million
licensed motorcycle riders in this country. That amounts to roughly one
out of every 36 people.

• Motorcycle riders have a 35% greater chance of dying in an accident
than those in a passenger car

• Motorcyclists account for nearly 14% of all traffic fatalities

• Over 5,000 people die annually in motorcycle accidents in the U.S.

In light of these statistics, perhaps it is not surprising that life insurance
companies are not big fans of motorcycles. Not only do they make coverage
harder to get for riders, they charge much higher premiums than they do
to non-motorcyclists for the same amount of coverage. While that may be
understandable, life insurers also then use the very act of riding a motorcycle
to deny valid claims against riders’ life insurance policies.

The tactics these insurers employ are varied, but the desired result is
the same. They simply want to avoid paying on claims after motorcyclists
have paid excessive premiums through the years. It is a practice that
is unfair and unwarranted.

As attorneys who specialize in the denial of life insurance claims, we
have seen every excuse insurers can come up with to deny death benefits
in cases of motorcycle fatalities. In this article, we’ll discuss
the most popular justifications for claim denials. We’ll also explore
why, in many cases, those denials are completely inappropriate.

The “material misrepresentation” denial

Insurance policies are nothing more than written contracts. At a base level,
the policyholder agrees to make premium payments and, in exchange, the
life insurer agrees to pay a death payout to beneficiaries when the policyholder
dies. As with any other contract, however, life insurance policies must
be based on the truth. Neither the insurance company or the potential
insured may lie or omit pertinent facts when the contract is being negotiated.

In the life insurance context, the obligation for the policyholder to tell
the truth arises at the time he is applying for insurance. The insurance
application asks dozens of questions about health, lifestyle, and hobbies
(such as riding motorcycles). Premiums are set based on the answers to
those questions. If an applicant’s lifestyle makes them more likely
to die sooner, premiums will be higher. It is simple math.

Not surprisingly, many insurers ask if the applicant is a regular motorcycle
rider. If the applicant answers “yes,” premiums will be higher
than they are for non-riders. But what if an applicant answers “no,”
and then later dies in a motorcycle accident?

For one thing, the insurance company will almost certainly deny any claim
for death benefits made by the rider’s beneficiaries. The company
will claim that the policyholder made a “material representation”
in applying for the policy, and therefore it should be relieved from holding
up its end of the bargain.

The analysis is rarely this simple, however. What if, for example, the
policyholder had never ridden a motorcycle at the time of the application,
but became an avid rider five years after the policy was issued? Alternatively,
what if the policyholder died one of the first times he rode a motorcycle?
In these scenarios, the application answers would have been true, notwithstanding
the ultimate cause of death.

Unfortunately, that won’t prevent life insurers from denying a claim
for benefits. That’s why it is so important to retain a lawyer who
specializes in such denials. We know that oftentimes, a “material
misrepresentation” denial is completely unwarranted. We’re
not intimidated by a strongly worded denial letter. In fact, we’ve
successfully contested such denials for years.

The “self-inflicted injury” denial

In other cases, the life insurance companies will deny policy coverage
based on a policy exclusion for “self-inflicted injuries.”
Under this exclusion, the insurer is relieved from paying accidental death
benefits if the policyholder died while engaged in activities that were
intended to cause self-harm.

Denials on this basis typically come in one of the following circumstances:
(1) the rider had been drinking prior to the fatal accident; (2) the rider
was driving at an excessive speed at the time of the accident; or (3)
the rider was weaving in and out of traffic at the time of the accident.
In all of these cases, the insurers argue that the policyholder’s
actions were so intrinsically dangerous that the person must have intended
to hasten their own death.

At first blush, denials on this basis can seem to make sense. From a legal
perspective, however, they are largely unfounded. In fact, courts have
repeatedly held that just because a policyholder engaged in a dangerous
activity doesn’t mean he intended to die. Courts have even gone
so far as to say that even where the policyholder was engaged in gross
negligence at the time of death, it doesn’t mean he intended self-harm.
In other words, unless there is concrete evidence of a rider’s actual
intent to harm himself while riding, most motorcycle fatalities are still
“accidents” that warrant coverage.

Beneficiaries of motorcycles riders need a specialized attorney

Like it or not, life insurance companies can be prejudiced against motorcycle
riders. They will do everything in their power to deny claims. They will
invoke confusing policy language and take positions in denial letters
that they know are contrary to prevailing law.

They are also counting on you not being able to tell them why they’re
wrong. That’s why the best move is for you to retain an attorney
who specializes in the denial of life insurance claims. We’ve handled
dozens of cases for motorcycle riders in the past. We know the tricks
and strategies life insurers use to deny coverage when a motorcycle fatality
is at issue. We also know we can beat them at their own game.

If you have had death benefits denied because the policyholder was involved
in a motorcycle fatality, please call us today. We’re here to help.

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